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Congenital arteriovenous malformations in the true pelvis are extremely rare: only 7 cases have been described in male patients. We report on a patient who presented with massive hemorrhage after transrectal prostatic biopsy and transurethral resection of the prostate. Diagnosis was established by means of magnetic resonance imaging and confirmed by arteriography. Our attempt at management by embolization and subsequent surgical ligation is described. A literature review and discussion of arteriovenous anomalies are presented.

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Although papaverine-phentolamine preparations are being employed for pharmacologic erection programs across the nation, their chemical properties have not been described in the literature. We found that the pH of papaverine-phentolamine solution in all concentrations tested remained less than 4.0. Attempts to buffer the solution resulted in a precipitate at a pH greater than or equal to 5.0. The pH of prostaglandin E1 was less than 5.0 but could be easily buffered to pH 7.4 or even 10.75 and remained stable. The effect of an acidic solution on corporal connective tissue and smooth muscle meshwork is unknown. We believe that buffering by blood will lead to the precipitation of papaverine-phentolamine and may cause primary intracorporal scarring. Extravasation or improper injection into the subcutaneous tissue exposes the mixture to blood and may secondarily result in additional scarring for the same reason. Therefore, prostaglandin E1 may be a more appropriate agent for penile injection.

Patients and surgeons frequently opt for laparoscopic appendectomy for treatment of acute appendicitis. Clinical studies have shown this approach to be a reasonable alternative to open appendectomy. The objective of the current study was to assess the outcome of laparoscopic appendectomy using three different techniques. The study sample consisted of 150 children with acute appendicitis who underwent surgery at Al-Azhar University Hospitals, Cairo, Egypt, and at Al Mishary Hospital in Riyadh, Saudi Arabia, between October 1997 and October 1999. The patients were allocated to undergo extracorporeal laparoscopic appendectomy, Endoloop laparoscopic appendectomy, or EndoGIA (Ethicon Endo-surgery, Inc., Cincinnati, OH, USA) laparoscopic appendectomy. All patients were assessed for the severity of the disease at baseline using clinical and hematologic indicators. The ages of the children ranged from 7 to 14 years, with a mean of 10 years (SD, 2.14 years). Of the children, 55.3% were female. The results showed that children who underwent laparoscopic appendectomy using the EndoGIA had statistically significant shorter operating times, did not have complications, and had the shortest duration of hospital stay (although duration of hospital stay did not reach the statistically significant level of P > 0.05). Therefore, the study showed that laparoscopic appendectomy using the EndoGIA is the procedure that is most recommended, except for the relatively high cost of the disposable materials. Endoloop laparoscopic technique was the second most preferable procedure, and the least preferred procedure was extracorporeal laparoscopically assisted appendectomy. The major drawback of the last technique is the high frequency of complications. Endoloop laparoscopic appendectomy with a purse-string suture can be performed safely if the EndoGIA is not available.

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